Bridging Medical and Mental Health: From the Doctor’s Office to the Therapist’s Couch

The doctor re-entered the office, looked at Alex, and said, “Well, your cholesterol is up and your blood pressure is running a little high. Other than that, things look fine.” Alex felt a mix of relief and confusion. “So I don’t understand—why am I exhausted all the time? Everything feels heavy and my migraines seem worse.” The doctor smiled reassuringly and said, “Sounds like you’ve been under a lot of stress. Try slowing down and exercising. Take the medication, and I want to see you for a follow-up.” Alex walked out with a familiar sense of dread and despair.

Studies indicate between 30% and 50% of patient visits to primary physicians result in medically unexplained symptom diagnoses. Also known as functional somatic syndrome (FSS), included are such ailments as gastrointestinal (GI) symptoms; back/arm/leg/chest/joint pain; headaches; fibromyalgia; chronic fatigue syndrome (CFS); and asthma. Research also continues to find a high correlation between stress/mental health and physical health. Because people may be more likely to visit a physician than a mental health specialist, physicians are in a unique position to advocate for increased mental health literacy and care.

Headaches/migraines: Stress and depression linked with chronic migraine. Comorbidity with anxiety is 2 to 5 times the rate for the rest of the population. Other associations: history of abuse, abandonment, isolation, dependence, shame, and emotional inhibition.

Furthermore, studies also found that patient health outcomes were impacted by the presence of psychosocial stress and mental health concerns among parents and caregivers of the patients. A study found moderate to severe depression and anxiety among 25% and 33% of caregivers, respectively. It seems such distress increased risk of neglectful treatment, medicinal mismanagement, abuse, and worsening relationship with the patient, which in turn correlated with compromised immune system, reduced physical health, and increased mortality among patients.

A health care model bridging medical and mental health is in the best interest of the people we serve—and fundamental for improved treatment outcomes.

Given such findings, it comes as no surprise such entities as the Global Initiative for Asthma, the American Heart Association, and the International Committee on Mental Health in Cystic Fibrosis support addressing psychosocial and mental health concerns as a standard of care.

Significantly, studies found brief behavioral psychotherapy interventions to positively impact health. For instance, relaxation and imagery techniques reduced stress, improved wound healing, and eased the severity of GI symptoms and conditions such as IBS, ulcerative colitis, and Crohn’s. Other brief interventions including improved coping skills were associated with reduced risk of inflammation, decreased blood pressure, and reduced anxiety and depression symptoms. Notably, studies also found the combination of brief psychotherapy interventions and psychopharmaceuticals associated with greater reduction in depressive symptoms than pharmaceuticals alone.

Despite findings and associations that seem to call for a collaborative medical and mental health model, screening for mental health concerns and making interventions is still not common practice among physicians. With the mounting understanding of the body-mind connection, it is paramount that all stakeholders become advocates toward an integrative health care approach.

Following are a few suggestions for mental health specialists, medical health specialists, and consumers of medical/mental health care on how to become proactive in this endeavor:

Mental Health Specialists

Meet and greet: Introduce yourself to general practitioners, OB-GYN doctors, nurses, and/or other professionals/specialties of interest in your community.

Survey and review: Explore doctors’ concerns for their patients and viable referral processes. Stay informed with the latest journals.

University of Missouri Health. (2017, February 10). Caregivers should be screened early, often to prevent depression, anxiety. Retrieved from https://www.sciencedaily.com/releases/2017/02/170210131222.htm

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

GoodTherapy.org is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.org.